Pacemaker surgery and subsequent Lead revisions ?

I put up a thread in the other disabilities forum asking something about Universal and IOA.

My surgery was on Nov. 5. Just merely a few hour after the implant, I began experiencing worsening arrhythmias, leading to extreme fatigue. They continued and continued. I went to the ER the following morning but was cleared. ( The ER doc definitely did not know how to read a chest x ray concerning a pacemaker). I went to a check-up that following Friday. A Medtronic lady came to check the pacemaker and had no capture of the ventricular lead even at the highest sensitivity. The cardiologist looked at the x ray and could immediately see the dislodgement of the lead. He operated on me to reposition the cable literally 3 hours later. I come home the same night.

The following morning, I experience similar arrhythmias. Even worse, the atrial lead was so dislodged that it caught the phrenic nerve and caused violent diaphragmatic contractions/stimulation.

The following Monday ( this monday) at the ER, a Medtronic guy told us the atrial lead was dislodged as so was the ventricular one. He had to up the voltage from 1.0 V to 5.0 V in the atrial lead to compensate. The cables were re-positioned the following day ( yesterday).

My parents are extremely mad at these occurrences and sometimes think I did it! ( buy moving my left arm violently)- it wasn't me

Has anyone had this happened to them? Mind you, these lead dislodgements have happened in a row.

I'm having my post-op check -up this friday. i pray that we will not hear that the leads are misplaced yet again!

I can't believe this one incision has been re-opened three times in a row.

I work with situations like this as a cardiac nurse. It won't go as far as to say it's common, but I will say it's not uncommon. The best advice I could give would be to make sure to go to someone extremely experienced in doing these procedures, preferably at a major medical center that does many cases per day where you are kept overnight, arm and body movement is restricted, and you are monitored for arrythmias and other problems like bleeding or lead displacement. (It sounds like you were discharged on the same day as the procedure?)

When we have problems like this, the electrophysiologist/MD actually comes to the patient with all sorts of fancy equipment and diagnoses the problem in the patient's room. (No Medtronic or other "technicians" needed. ) If something needs to be fixed or readjusted, then the patient goes back to the procedure area. Once fixed, that's usually the end of it. (Although never say never - problems can develop down the road, but they're fairly rare.)

I see you are in PR. I don't know anything about the medical system down there, but do you have a major medical center that specializes in cardiac procedures that you could go to to have this repaired/redone? I have seen it happen on occasion that ones put in badly elsewhere, or those that developed inadvertent problems, were taken out completely, allowed to heal, and then redone. (But that would depend on whether the underlying condition that warranted a pacemaker in the first place could go without. If not, sometimes they are either redone right away or a temporary pacemaker is used for a shorter time and then the procedure redone.) If it were me I would, at this point, go to a place like that for a consult and see what can be done now to correct this situation. You shouldn't have to keep going back and forth for problems that weren't corrected right in the first place and living with that sort of discomfort and anxiety in the meantime.

Good luck. I know it seems exasperating right now, but hopefully once you have it corrected you won't have any further problems.

I work with situations like this as a cardiac nurse. It won't go as far as to say it's common, but I will say it's not uncommon. The best advice I could give would be to make sure to go to someone extremely experienced in doing these procedures, preferably at a major medical center that does many cases per day where you are kept overnight, arm and body movement is restricted, and you are monitored for arrythmias and other problems like bleeding or lead displacement. (It sounds like you were discharged on the same day as the procedure?)

When we have problems like this, the electrophysiologist/MD actually comes to the patient with all sorts of fancy equipment and diagnoses the problem in the patient's room. (No Medtronic or other "technicians" needed. ) If something needs to be fixed or readjusted, then the patient goes back to the procedure area. Once fixed, that's usually the end of it. (Although never say never - problems can develop down the road, but they're fairly rare.)

I see you are in PR. I don't know anything about the medical system down there, but do you have a major medical center that specializes in cardiac procedures that you could go to to have this repaired/redone? I have seen it happen on occasion that ones put in badly elsewhere, or those that developed inadvertent problems, were taken out completely, allowed to heal, and then redone. (But that would depend on whether the underlying condition that warranted a pacemaker in the first place could go without. If not, sometimes they are either redone right away or a temporary pacemaker is used for a shorter time and then the procedure redone.) If it were me I would, at this point, go to a place like that for a consult and see what can be done now to correct this situation. You shouldn't have to keep going back and forth for problems that weren't corrected right in the first place and living with that sort of discomfort and anxiety in the meantime.

Good luck. I know it seems exasperating right now, but hopefully once you have it corrected you won't have any further problems.

Click to expand...

I had my procedures done at the largest medical center in the island, the largest cardiovascular center in the Caribbean. After this post, I had one more surgery for the atrial lead extraction on Dec. 5. I'm having my first PM check-up since the last surgery on the 9th..and i leave for Orlando on the 11!

Correct, all the times I was released on the same day of the procedure. Thank you for your input!!

I have an ICD (similar to pacemaker but is a defibrillator as well) made by Medtronic implanted in 2006 and replaced in 2009 or 2010 because of rapid battery drain. It was a manufacturing glitch. I do not have an open arteries to drop the leads into so my leads had to be sewn onto my heart. When the leads start to fail, they will have to open me up and sew new leads onto the heart. So I've never experience what you have.

However, I had a cardiac friend who had an ICD placed in October or November as well in the San Francisco area who had problems. She kept experiencing numbness and severe pain in her arm. It was looked at by a doctor that didn't do the surgery and he couldn't figure it out. She finally went back to where she had the ICD placed and the EP team there found that one of the leads was not where is should've been. Somehow without surgery though they were able to move it slightly and things improved immediately for her.

Hopefully everything went well and the leads are where they should be.